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. 2019 Feb 4:6:78-84.
doi: 10.1016/j.ejro.2019.01.007. eCollection 2019.

Cardiovascular magnetic resonance T2* mapping for structural alterations in hypertrophic cardiomyopathy

Mareike Gastl  1   2   3 , Alexander Gotschy  1   2 , Jochen von Spiczak  4 , Malgorzata Polacin  4 , Florian Bönner  3 , Christiane Gruner  1 , Malte Kelm  3 , Frank Ruschitzka  1 , Hatem Alkadhi  4 , Sebastian Kozerke  2 , Robert Manka  1   2   4
Affiliations

Cardiovascular magnetic resonance T2* mapping for structural alterations in hypertrophic cardiomyopathy

Mareike Gastl et al. Eur J Radiol Open. .

Erratum in

Abstract

Purpose: Hypertrophic cardiomyopathy (HCM) is characterized by a heterogeneous morphology and variable prognosis. A mismatch between left ventricular mass (LVM) and microvascular circulation with corresponding relative ischemia has been implicated to cause myocardial replacement fibrosis that deteriorates prognosis. Besides parametric T1 mapping, Cardiovascular Magnetic Resonance (CMR) T2* mapping is able to identify ischemia as well as fibrosis in cardiac and extracardiac diseases. Therefore, we aimed to investigate the value of T2* mapping to characterize structural alterations in patients with HCM.

Methods: CMR was performed on a 1.5 T MR imaging system (Achieva, Philips, Best, Netherlands) using a 5-channel coil in patients with HCM (n = 103, 50.6 ± 16.4 years) and in age- and gender-matched controls (n = 20, 44.8 ± 16.9 years). T2* mapping (1 midventricular short axis slice) was acquired in addition to late gadolinium enhancement (LGE). T2* values were compared between patients with HCM and controls as well as between HCM patients with- and without fibrosis.

Results: HCM patients showed significantly decreased T2* values compared to controls (26.2 ± 4.6 vs. 31.3 ± 4.3 ms, p < 0.001). Especially patients with myocardial fibrosis presented with decreased T2* values in comparison to those without fibrosis (25.2 ± 4.0 vs. 28.7 ± 5.3 ms, p = 0.003). A regression model including maximum wall thickness, LVM and T2* values provided good overall diagnostic accuracy of 80% to diagnose HCM with and without fibrosis.

Conclusion: In this study, parametric mapping identified lower T2* values in HCM patients compared to controls, especially in a sub-group of patients with myocardial fibrosis. As myocardial fibrosis has been suggested to influence prognosis of patients with HCM, T2* mapping may add information for identifying a higher risk sub-group of HCM patients.

Keywords: CMR; Fibrosis; Hypertrophic cardiomyopathy; T2* mapping.

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Figures

None
Graphical abstract
Fig. 1
Fig. 1
T2* measurement within the IVS of a midventricular slice of a patient with HCM by placing a standardized ROI. HCM, hypertrophic cardiomyopathy; IVS, interventricular septum; ROI, region of interest.
Fig. 2
Fig. 2
Comparison of T2* values between patients with HCM and a healthy control group. HCM, hypertrophic cardiomyopathy.
Fig. 3
Fig. 3
(A) T2* map of a normal control (upper panel) compared to a patient with HCM (lower panel) and (B) LGE image (upper panel) and corresponding T2* map (lower panel) to visualize the reduction of T2* values in the areas of myocardial fibrosis. HCM, hypertrophic cardiomyopathy; LGE, late gadolinium enhancement.
Fig. 4
Fig. 4
Comparison of T2* values between patients with (+) and without (-) LGE. LGE, late gadolinium enhancement
Fig. 5
Fig. 5
ROC analysis to differentiate HCM with- and without fibrosis adding LVMi, IVS and T2* to the model. ROC, receiver operating characteristics; LVMi, left ventricular mass indexed by body surface area; IVS, interventricular septum.
See this image and copyright information in PMC

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